January 29, 2013

Cancer Patients Who Refuse Mastectomies May Be More Likely To Survive

A new study by the Duke Cancer Institute discovered that women who were diagnosed with early stage breast cancer and received breast-conserving surgery had equal or better survival rates than women who had breast removal surgery.

In a breast-conserving surgery, or lumpectomy, surgeons attempt to remove only the lump or cancerous tumor from the breast while leaving the breast intact. In a mastectomy, by contrast, the entire breast is removed. Many women undergo mastectomies in the hope that the procedure will remove the entire tumor or tumors quickly and efficiently, providing the best possible opportunity for survival.

For this study, the researchers found that early stage breast cancer patients who had a lumpectomy had a 19 percent lower chance of dying from any cause over the nine-year period following the procedure compared to women who received a mastectomy. The team of investigators stated that there has been an increase in the number of mastectomies performed among specific groups of patients, and they hope that the study results will help to lessen anxiety for patients who are considering the more conservative surgery.

According to Mail Online, the research was conducted over a ten-year period and included 112,154 females in California who were diagnosed with early stage breast cancer between 1990 and 2004. Each of the patients received either a lumpectomy followed by radiation therapy for five to six weeks after the procedure, or a mastectomy. Over the course of the study, some 31,416 of the patients died, and approximately 39 percent of these deaths were attributed directly to breast cancer.

“Our findings support the notion that less invasive treatment can provide superior survival to mastectomy in stage one or stage two breast cancer,” Dr. E. Shelley Hwang, the study´s lead researcher and chief breast surgeon at Duke Cancer Institute, told Mail Online. “Given the recent interest in mastectomy to treat early stage breast cancers, despite the research supporting lumpectomy, our study sought to further explore outcomes of breast-conserving treatments in the general population comparing outcomes between younger and older women.”

In the article, the researchers emphasized that the value of lumpectomies may differ from patient to patient. For example, the procedure is not recommended for individuals who have had chest radiation in the past, patients who have specific genetic mutations, or who have large tumors or a number of tumors in one breast. Lumpectomies, however, were particularly beneficial for women over the age of 50 as well as patients whose tumors were sensitive to hormones such as estrogen and progesterone.

"It's good news in that a lot of women sometimes come in and feel that a mastectomy must be better than breast conservation," explained Dr. Stephanie Bernik, Lenox Hill Hospitals´ chief of surgical oncology.

Experts note that the results could have been influenced by differences that were not accounted for, such as varying access to health care. One weakness of the study is that it could not provide information on the likelihood of cancer recurrence for patients who had lumpectomies. However, others say that despite these weaknesses, the study´s results are still helpful.

“We welcome these significant findings, as we have known for some time that lumpectomy and radiotherapy is as effective as mastectomy for some women. These findings go further to suggest that lumpectomy with radiotherapy could be better than mastectomy in early stage invasive breast cancer,” said Sally Greenbook, a senior policy officer at the UK´s Breakthrough Breast Cancer organization.

"We know, through speaking to women with breast cancer every day, how difficult it is to choose between a mastectomy and a lumpectomy. This study provides further reassurance allowing women to be more confident when making this decision. More research is needed to confirm these results, and we urge anybody concerned to speak to their surgeon so they can make an informed decision, as every choice is personal,” Greenbook continued.

The findings of the study were recently featured in the journal Cancer.